I was asked recently to address a graduate level healthcare administration class. The instructor is the chief financial officer of a long time client and I was not exactly in the position to refuse. So, on an otherwise beautiful spring Saturday afternoon, I was scheduled for two hours with some folks interested in learning more about the “real” world of healthcare markets and raising capital.

I decided to begin with a history of how capital had been raised over the last fifty or so years. Therefore, I started with philanthropy and made my way through employer financed group health plans. That led to the Hill Burton program and then to Medicare and Medicaid. I worked my way through cost based reimbursement to prospective payment systems for both operations and then capital. I rounded out my remarks with public offerings, exempt financing, and joint ventures.

That was when I glanced at my watch and realized I had lots of time left. So next I began to riff on budgeting and how healthcare markets do not reflect certain market forces that exist in other industries. For one, there are guaranteed payments (at some level) for much of the business in healthcare. This is either through insurance or a government program. Secondly, demand for the service provided is pretty much a given in most cases. Neither of these things is true if I am launching a new service or product business. At this point, I was getting a few smiles and nods.

I then proceeded to raise healthcare reform and contrast current discussions with the Clinton’s plan of the early nineties. I finally was getting the class engaged. Forget that I had run out of material twenty minutes earlier. I was challenged by one of the students about why the USA did not have a system like Canada. I replied with the common snide argument that the Canadian system only worked because the three thousand mile border it shared with us made our healthcare system available to Canadians. I do not think I persuaded her.

I share all this to remind you all about the reasoned discussions that are going on in classrooms and public policy forums. I recently heard some striking commentary from Patricia Maryland, the CEO and President of St. Vincent Hospital and Healthcare Center. She serves on the national commission studying healthcare delivery and financing. That group will be reporting to Congress in the fall of this year. Her remarks from the study and public hearings the commission has held suggest some profound lessons have been learned and will be shared. Watch for the reports on that important work.

Do not wait for this commentator to “shock and awe” anyone with his insight. I may have survived a Spring afternoon in Indianapolis, but that was a one shot deal. I am better off listening to the true visionaries that so often present at our Section programs and events, and to smart folks like Dr. Maryland. Is healthcare reform finally going to happen? Can we afford not to welcome that reform? Stay tuned. Take care.